Michael Campos, Ph.D.

In the past few decades gambling has become an increasingly available and socially acceptable activity; however, some individuals who gamble do so in a way that results in severe and wide-ranging negative consequences. Although the majority of individuals who gamble do so without experiencing problems, many people have themselves suffered, or know friends and family members who have suffered dire personal, financial, and social consequences as a result of their gambling behavior.

What is gambling?

A general definition of gambling is risking something of value on an event for which the outcome is uncertain. This definition is broad and includes not only such things as casino-style gambling, sports betting, wagering on animal races, bingo, and slot machine gambling, but also things like office pools, the lottery, and wagering between friends, family, and acquaintances. Although one often thinks of gambling as involving monetary risk, there are many other types of bets that can be made including those involving possessions or behaviors. Although risk is inherent in many aspects of life, the difference between gambling and healthy risk taking is in the degree of uncertainty regarding outcomes. Gambling involves outcomes which are determined entirely, or nearly entirely, by random chance rather than by skill, hard work, merit, or other factors. Gambling often involves events which, though seemingly patterned, are not dependent on any previous outcomes.

The different levels of gamblers

The spectrum of gambling behavior can be divided into non-gamblers, social gamblers, at-risk gamblers, problem gamblers, and pathological gamblers. Non-gamblers do not engage in gambling activity. Social gamblers may use gambling as a recreational activity, often gamble with friends, stay within predefined limits and strategies, and experience no negative consequences as a result of their gambling. At-risk gamblers are those gamblers who have experienced at least one, but less than three gambling-related negative consequences. Problem gamblers have experienced at least three, but less than five gambling-related problems. Gamblers who have experienced five or more serious gambling-related problems meeting specific psychiatric criteria are pathological gamblers. One should note that only pathological gambling is a recognized psychiatric diagnosis. The other categories are often used in epidemiologic research and may consist of some individuals who successfully moderate their gambling behavior in response to negative consequences before developing pathological gambling, and some individuals who may fail to moderate gambling behavior and progress towards pathological gambling.

Pathological gambling (or gambling addiction) – DSM definitions

Pathological gambling is a disorder characterized by recurrent and maladaptive gambling behavior accompanied by cognitive/somatic symptoms (i.e., preoccupation with gambling, tolerance, withdrawal), behavioral symptoms (i.e., loss of control of gambling, chasing losses, escape gambling, lying about gambling behavior, engaging in illegal acts to support gambling), and psychosocial consequence symptoms (i.e., social, occupational or relationship problems, bailouts), all occurring in the absence of mania.

Pathological gambling has been formally defined in the American Psychiatric Associations (APA) Diagnostic and Statistical Manual (DSM) since 1980, but the diagnostic criteria have changed over time. Some of the key features of gambling problems include a loss of control over gambling behavior, preoccupation with gambling, and lying to others about the extent of one’s gambling behavior.

The most recent version of APA’s DSM (DSM-IV-TR; APA, 2000) includes ten criteria and a rule out for gambling that is better accounted for by a manic episode, which is a state of elevated mood, increased reward seeking behavior, and risk taking that occurs in one phase of bipolar disorder. The DSM-IV-TR requires five symptoms, with no particular time frame, to meet criteria for the disorder of pathological gambling. Although not a formal diagnosis, individuals with problem gambling may benefit from treatment to help them stop or reduce their gambling.

How common is pathological gambling – U.S. statistics

The estimates of the occurrence of pathological gambling range from 0.42% to 2% of the United States general population. Although these numbers may seem low, they are similar to those seen for other psychiatric disorders such as schizophrenia and bipolar disorder. One large-scale, community based study, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) found that more pathological gamblers were male, black, aged 45-64, unmarried, and living in the Western United States. Notably, research suggests that the occurrence of pathological gambling is associated with increases in gambling opportunities. Given the increasing availability of gambling, it is likely that more individuals will develop gambling-related problems in the coming decades.

In future articles we will look more in depth at the treatment for pathological gambling (or gambling addiction) and additional aspects of the disorder.